05-07-2024, 03:54 PM
Help with moving from Lowenstein APAP to Resmed Bi-Level
WHAT’S BROUGHT ME HERE
I’m looking for advice on moving from APAP to Bi-level therapy.
I think I’ve reached the limits of what my Lowenstein machine can offer me, and so have purchased a Resmed AirCurve 10 Vauto to try and address underlying UARS? (FLs and RERAs) using Pressure Support.
Does anyone have any thoughts on a starting set of values to kick off the titration process on a Vauto - any guidance would be welcome.
I’m very curious to see how this will go, particularly how the Resmed will ‘feel’ compared to the Lowenstein, given their differing approaches to pressure delivery.
My current Lowenstein APAP settings are - APAP, Dynamic Mode, Pmin 10, Pmax 15, No SoftPAP.
SOME BACKGROUND
Started PAP therapy Oct 2023, after home sleep study reported AHI=35.7 (76% of which were hypopneas).
AHI quickly brought down to less than 1 after first couple of days on my Lowenstein PrismaSMART APAP machine (even at Pmin 4 / Pmax 20) and has remained that way since.
I’ve only had the occasional random CSR, CA, OA or H since starting, so not too concerning.
First couple of months I felt really revitalised, (possibly sleep debt repaid), but more recently I’ve not been feeling fully rested and been progressively suffering with fatigue and brain fog.
My suspicions are that the remaining and consistently high FLs / RERAs are at the root of my fatigue and brain fog. These don’t seem to respond to further increases in either Pmin or SoftPAP - my only two levers on APAP.
Pmin was gradually increased to 10 to deal with FLs and RERAs with some success - above this level, I started to get central apneas and (central) hypopneas emerging, as well as intercostal muscle aches and aerophagia.
When SoftPAP is ON, my FLs in fact more than double?! (note: OSCAR does not display FLs when SoftPAP is OFF - their extent has to be inferred from within the ‘Details’ sidebar).
When displayed, the FLs look positional (very banded), but don’t correlate with L, R, Supine or Prone (SomnoPose App). I’m a side sleeper, use a low pillow and wear a Soft Cervical Collar each night, and while this has ‘thinned out’ the FLs, a lot still remain.
I get a fair amount of what Lowenstein refer to as ‘Deep Sleep’ (i.e. stable respiration), but this is fragmented due to the arousals from the FLs. These arousals seems to happen at the end of ‘deep sleep’ phases or during periods of REM sleep (Apple watch data).
Looking at my flow rate chart, my breathing has always looked pretty ratty, with no two wave forms ever looking the same, even during periods of so-called ‘deep sleep’. I’ve always put this down to just my individual physiology, but it might be better described as UARS.
I’ve attached two OSCAR Charts - last night’s with SoftPAP=OFF and previous night with SOFTPAP=ON (i.e with FLs visible) and can provide further ’zoomed in’ charts if required.
...and thanks again - all thoughts welcome.
I’m looking for advice on moving from APAP to Bi-level therapy.
I think I’ve reached the limits of what my Lowenstein machine can offer me, and so have purchased a Resmed AirCurve 10 Vauto to try and address underlying UARS? (FLs and RERAs) using Pressure Support.
Does anyone have any thoughts on a starting set of values to kick off the titration process on a Vauto - any guidance would be welcome.
I’m very curious to see how this will go, particularly how the Resmed will ‘feel’ compared to the Lowenstein, given their differing approaches to pressure delivery.
My current Lowenstein APAP settings are - APAP, Dynamic Mode, Pmin 10, Pmax 15, No SoftPAP.
SOME BACKGROUND
Started PAP therapy Oct 2023, after home sleep study reported AHI=35.7 (76% of which were hypopneas).
AHI quickly brought down to less than 1 after first couple of days on my Lowenstein PrismaSMART APAP machine (even at Pmin 4 / Pmax 20) and has remained that way since.
I’ve only had the occasional random CSR, CA, OA or H since starting, so not too concerning.
First couple of months I felt really revitalised, (possibly sleep debt repaid), but more recently I’ve not been feeling fully rested and been progressively suffering with fatigue and brain fog.
My suspicions are that the remaining and consistently high FLs / RERAs are at the root of my fatigue and brain fog. These don’t seem to respond to further increases in either Pmin or SoftPAP - my only two levers on APAP.
Pmin was gradually increased to 10 to deal with FLs and RERAs with some success - above this level, I started to get central apneas and (central) hypopneas emerging, as well as intercostal muscle aches and aerophagia.
When SoftPAP is ON, my FLs in fact more than double?! (note: OSCAR does not display FLs when SoftPAP is OFF - their extent has to be inferred from within the ‘Details’ sidebar).
When displayed, the FLs look positional (very banded), but don’t correlate with L, R, Supine or Prone (SomnoPose App). I’m a side sleeper, use a low pillow and wear a Soft Cervical Collar each night, and while this has ‘thinned out’ the FLs, a lot still remain.
I get a fair amount of what Lowenstein refer to as ‘Deep Sleep’ (i.e. stable respiration), but this is fragmented due to the arousals from the FLs. These arousals seems to happen at the end of ‘deep sleep’ phases or during periods of REM sleep (Apple watch data).
Looking at my flow rate chart, my breathing has always looked pretty ratty, with no two wave forms ever looking the same, even during periods of so-called ‘deep sleep’. I’ve always put this down to just my individual physiology, but it might be better described as UARS.
I’ve attached two OSCAR Charts - last night’s with SoftPAP=OFF and previous night with SOFTPAP=ON (i.e with FLs visible) and can provide further ’zoomed in’ charts if required.
...and thanks again - all thoughts welcome.
